Chapter 478: Trust in the Hands That Heal

Pneumothorax can be divided into two major categories based on cause: primary and secondary.

This patient, who experienced their first case of pneumothorax after a fit of shouting, falls under primary pneumothorax. Men are far more likely to develop this than women—about a six to one ratio.

In men, pneumothorax mostly happens when large subpleural bullae rupture.

It’s especially common in tall, thin people who are more prone to spontaneous pneumothorax.

After making his diagnosis Zhou Can was certain this was a left-sided spontaneous tension pneumothorax.

Just now, he’d used an 18-gauge needle to puncture the left second intercostal space along the midclavicular line to vent the chest. But even after treatment, the symptoms of pneumothorax remained severe.

He’d thought this would be an easy case, one that would be solved without a hitch. Yet things hadn’t gone as planned.

Holding the X-ray chest film, Zhou Can scrutinized it again, mind racing for a solution.

“Performing a closed left chest tube drainage to remove the trapped air might be the best approach.”

After careful consideration, he decided to use this procedure for the patient’s treatment.

There are two main indications for closed chest drainage: first, if the lung is compressed over 30%, and second, for tension pneumothorax. This patient met both criteria—it was absolutely appropriate.

There are two main chest tube insertion methods: the trocar technique and the incision technique.

The incision method isn’t a major operation—an incision of roughly 1.5 centimeters is all that’s needed.

Both approaches work on similar principles and each comes with its own pros and cons.

Zhou Can preferred the incision method.

It’s simpler and delivers quicker results.

After discussing options with the family, they put their trust in him and agreed to move forward.

That kind of trust is truly rare.

Since the first needle aspiration hadn’t worked, most families would be questioning the doctor’s abilities by now.

Given how young Zhou Can looked, it would be easy for them to wonder if he was up to the task.

There’s no denying it—mutual trust between doctors and patients is vital. It gives the doctor extra motivation, freedom and the courage to act decisively.

If a patient’s family is overly difficult, always doubting the doctor, it pushes doctors to become instinctively cautious.

That leads doctors to favor conservative treatments above all.

Director Xue gave full support, quickly arranging a temporary operating room for Zhou Can to use.

After infiltrating the patient’s pleura with local anesthetic, the surgery began.

This wasn’t something that required the main operating room—it could be done right in the ward.

Assisted by the instrument nurse, Zhou Can gripped a classic leaf-shaped scalpel and made a 1.5-centimeter cut in the skin over the patient’s chest. After cutting through the subcutaneous tissue, he used long curved hemostats to bluntly dissect down to the pleura.

His movements were smooth and confident—quick and precise.

Once he’d reached the pleura, he carefully advanced the drainage tube along the dissected tract into the chest cavity.

It looked easy, but every step demanded real surgical finesse.

A minute on the table takes ten years to master.

Even for a small procedure like this, placing a drainage tube into the chest brings its own risks.

Bluntly dissecting through the chest wall to the pleura is no joke.

If you rip things the wrong way, you could open up a huge hole in the patient’s chest cavity.

Once the tube was in place, he secured it tightly and hooked it up to the connecting line.

“Can you hear me?”

Zhou Can turned to the patient.

“Yeah, I can!”

The patient’s voice was still weak. Just talking made his chest hurt.

With pneumothorax, even breathing is painful.

People often compare heartbreak to a pain so sharp they can’t breathe. Turns out, having a pneumothorax feels eerily similar.

“Try taking a deep breath for me.”

Zhou Can coached the patient to breathe deeply.

There were two reasons: first, to observe the water seal bottle for any fluctuation in the water level. Second, deep breathing helps the collapsed lung re-expand faster.

The patient’s left lung was over 90% compressed. That was about as serious as it gets.

Helping the lung re-inflate as soon as possible would be vital to his recovery.

“It hurts, it hurts a lot!”

The patient tried taking a deep breath, but halfway through, he grimaced and gave up.

“You still have some local anesthetic working right now. I know it’s just a local block, but it should help a bit with the pain. If you can’t handle even this, that won’t do. Come on, keep going—you’re tougher than that. I’m right here, nothing’s going to happen to you on my watch.”

Zhou Can encouraged him to try again.

For many patients, enduring pain is one of the hardest hurdles.

He gave it another shot. Still hurt, but not as badly as the first time.

“Alright, stop deep breathing for now!”

Zhou Can called a halt, watching the water seal bottle intently, brow furrowed. The tube was clearly in, connected properly—so why was the water column perfectly still?

Thankfully, there was negative pressure.

If there’s no fluctuation, and no negative pressure, that could mean the tube has a leak or fallen out. That needs immediate attention.

But Zhou Can had just made sure the tube was anchored.

With negative pressure, there’s no leak.

That left two options—the lung had fully re-expanded, or the tube was blocked.

He figured the chance of full re-expansion was slim.

He suspected the tube had gotten blocked during placement.

He adjusted the tube and had the patient try another deep breath. This time, the water column moved.

Problem solved.

Turns out, the tube had probably been inserted a bit too deep and got blocked by tissue inside the chest.

“Alright, keep taking deep breaths, things are looking good!”

Guided by Zhou Can, the patient kept up the deep breathing. Everything checked out.

No issues found.

The patient was transferred back to the inpatient ward, and Zhou Can gave the attending doctor and nurses clear instructions: monitor vital signs closely, provide oxygen, prevent infections, use bronchodilators, and help clear out any mucus.

Director Xueyan had been waiting for Zhou Can to finish all along.

She sent a nurse over to hurry him along—there were surgery patients waiting for him in the operating suite.

With Zhou Can by her side during difficult surgeries, it was like having an extra layer of protection. Sometimes, if a surgery got tricky or needed urgent intervention, Zhou Can could even step in as the primary surgeon.

If critical events cropped up—cardiac arrest in the middle of surgery, sudden fibrillation, plummeting oxygen levels—his steady hands could turn the tide.

Zhou Can always had a knack for rescuing patients.

After spending two years learning from Director Feng in anesthesiology, his skills had only gotten sharper.

There were times when, in the operating room, patients got into trouble—and even senior physicians like Dr. Dongfang Xueluo would call Zhou Can for help.

……

The next day, still worried, Zhou Can went to check on the pneumothorax patient right after his rounds in the Emergency Department, making a special trip to Cardiothoracic Surgery’s ward.

After examining him and asking a few questions, he saw the left chest pain had eased, and shortness of breath had improved dramatically. The patient was obviously much better.

His family was extremely grateful to Zhou Can, and seeing the marked improvement, both the patient’s mother and sister finally relaxed.

The nurse let Zhou Can know the patient had a low-grade fever.

A low-grade fever was normal in this situation.

Zhou Can borrowed the nurse’s stethoscope and listened carefully to the patient’s lungs.

“The breathing sounds in his left chest are still a little quiet, but there’s no rales—just keep practicing deep breathing. And whatever you do, don’t touch that drainage tube. If it loosens or shifts, let a nurse or the attending know right away.”

All in all, treating pneumothorax is never without risks.

Back during his training in Cardiothoracic Surgery, Zhou Can had witnessed a patient die from complications of chest tube drainage.

That lesson was a harsh one—a mix of a careless nurse, a distracted doctor and, worst of all, a patient and family who broke instructions by fiddling with the water seal bottle.

There are dangers most families and patients would never realize without a medical background.

Sometimes, even trained professionals with less experience or attentiveness can overlook these risks.

Years later, Zhou Can still treated pneumothorax patients with extra caution.

He’d remind the attending doctors and nurses again and again—this was not the time to get careless.

After more than ten hours, there was still a moderate amount of gas bubbling from the water seal bottle, and the amount of bloody drainage reached over 900 milliliters—bright red.

That meant there was bleeding.

The attending hadn’t called for help, but had already taken effective measures.

He administered transfusions and fluids, plus intravenous cefradine for infection control.

Aminomethylbenzoic acid was given intravenously to stop the bleeding.

These treatments were timely and appropriate—so much so that Zhou Can was genuinely impressed.

After over twenty senior staff got poached from Cardiothoracic Surgery, the department gained the chance to bring in a new wave of young medical talent. Vitality slowly returned.

It’s a core department, after all, and Tuyu Hospital carries a lot of weight.

Plenty of graduates with their advanced certifications and degrees are lining up for a spot at this top-tier hospital.

Many of these doctors are full-fledged general practitioners.

Actually, most medical students now lean toward general practice when they pick a specialty. Never mind all the mentors saying you shouldn’t bite off more than you can chew.

But that’s the perspective of someone who’s already made it.

For an ordinary medical student, the questions that really matter are: How do I land a job? How do I get into a top hospital’s key department?

General practitioners have a lot more opportunities—and better chances—when applying to big hospitals.

Even med students who return with doctorates or overseas degrees, like Du Leng, have to relearn practical skills from the ground up once they start working in a hospital.

If you carry your nose in the air forever, you’re likely to end up all theory and no practice—and get outperformed by someone like Zhou Can, a regular Bachelor’s graduate.

“Sorry, sorry! I had to run over because patient in bed 55 developed arrhythmia. Dr. Zhou, let me make a note—what orders have you given so far?”

The attending doctor today wasn’t the same intern who’d brought the patient from emergency yesterday.

Instead, it was a young male doctor named Pu.

He looked to be just over thirty, with a crew cut, rimless glasses, a round face, broad temples and a square jaw. At first glance, he came across as practical, sincere and approachable.

“The transfusions, the hemostasis, infection control last night—that was all you?”

Zhou Can was genuinely impressed by this doctor.

“Yeah… that was me. Honestly, it was already close to 1 a.m., and you were still busy with that late surgery, so I didn’t want to disturb you. Did I miss something important?”

Dr. Pu was also a resident, though a few years older than Zhou Can.

Right now, he was speaking to Zhou Can in the lower position.

It was a gesture of respect.

No one had taught him to act this way; it was just a survival instinct in the workplace.

“You did great. When a patient develops hemopneumothorax, this is exactly how you deal with it. As long as you keep effective drainage, and the lung re-expands to press on the bleeding, most cases will resolve on their own. But if bleeding continues, then you have to consider surgery to stop it. Make sure you tell the next shift to keep a close eye on things.”

Zhou Can wasn’t trying to put on airs.

Even when an attending talked to him, it was almost always in this same tone.

He’d tried speaking more politely before, but that only made people nervous, and conversations dragged on forever.

Small talk and empty pleasantries took too much time—Zhou Can preferred to stay direct.

He was honest to a fault, never one for fake niceties. So now, he simply went with what felt natural.

“Got it, I’ll make sure everything’s clear at handover.”

Dr. Pu earnestly wrote down every instruction.

“Dr. Zhou, would you mind explaining the causes of bleeding in these cases? There’s often a big gap between the textbook and real practice, and I’d like to learn more hands-on experience from you.”

He smiled as he asked.

“Bleeding in hemopneumothorax is mainly caused by tearing the adhesions between the visceral and parietal pleura. Most of the bleeding comes from torn small arteries where the adhesions attach to the chest wall. Once the lung re-expands and presses on the bleeding, it usually stops. Most cases don’t need surgery. You did a great job with blood transfusion and hemostatic drugs.”

As he shared his real-life clinical experience, Zhou Can didn’t hold back his praise.

“Hemopneumothorax happens mostly in young male patients, and it’s more common on the left side than the right. It tends to sneak up and is often missed, so diagnosis can easily be delayed. That’s why I made a point of telling everyone to monitor for signs of internal bleeding.”

After finishing the chest tube procedure yesterday, Zhou Can had left some oral orders.

He hadn’t mentioned exactly what to do if hemopneumothorax developed.

He trusted that the attending and nurses would report up the chain if anything went wrong.

If it hadn’t been for two major surgeries waiting in the operating room, he might have caught the bleeding himself with a bit more observation.

Based on last night’s chest tube output, the bleeding was severe.

Hopefully, they won’t need surgery to control it.

Sadly, illness doesn’t care what the doctor wants. It won’t show mercy just because a family is struggling.

Illness is ruthless—often cruel beyond measure.

That’s why this patient must be monitored extra closely to avoid any surprises.

“One more question, Dr. Zhou: after closed chest tube drainage, how long does it usually take to judge if more surgery is needed?”

Dr. Pu made sure to jot down all of Zhou Can’s key points.

“A good memory isn’t as reliable as pen and paper.”

There’s so much for a doctor to learn—taking notes is always worth it.

“If air is still leaking after twenty-four hours, you need to consider a new approach. For most patients, the gas in the water seal bottle decreases after three or four days before stopping altogether. But if there’s still gas after a week, the tear may be too large for the tube to seal—it’ll require surgery to repair.”

Whether with newcomers or senior staff, Zhou Can always shared whatever he knew, teaching with patience.

That willingness to mentor was a trait passed down from the likes of Dr. Hu Kan, Dr. Xu, and Chief Resident Shen.

Every mentor Zhou Can had encountered—no matter how withdrawn they seemed—would find time for him as long as his questions were thoughtful and he was clearly there to learn.

So far, not once had he met an attending who refused to teach.

Even Director Feng from the Anesthesiology Department, cool and reserved as he was, had come to Zhou Can, inviting him to learn.